Aims: The aims of this project are to determine whether clinical stability following depression treatment in pregnant women normalizes neuroendocrine function, as well as infant neuroendocrine status, birth outcomes and state regulation through 6 months. Design: Following screening in obstetrics clinics, pregnant women diagnosed with MOD during structured clinical interview will receive a course of interpersonal therapy (IPT) with or without treatment with an SSRI, beginning at 28 gestational weeks and continuing through 6 months. Maternal outcome variables will include: symptom severity, psychosocial variables, neuroendocrine measures (ACT-H, cortisol, CRH, CRH-BP), and pregnancy characteristics. Infant outcome variables include birth outcomes (weight, gestational age, APGAR scores), neonatal neurologic assessments, cord blood and salivary neuroendocrine measures, state regulation variables (feeding, sleep, crying) and developmental measures through 6 months of age. Broad Objectives: Elevated maternal stress hormones deriving from an activated limbic-hypothalamic-pituitary axis during depression in pregnancy may play a role in increased uterine irritability and premature delivery. Little is known about whether depression treatment reverses these negative effects or impacts the neuroendocrine system in the mother or child. The proposed project focuses on several questions which inform treatment decisions in pregnancy: 1. Does response to treatment during regnancy improves pregnancy outcomes? 2. Does the LHPA in pregnant women who respond to treatment differ from those who do not? 3. Do abnormalities in the LHPA in women impact the development of the LHPA in their offspring? 4. Does the infant LHPA impact neonatal regulation of feeding and sleep? 5. Do pharmacologic treatments during pregnancy differentially impact neonatal state regulation due to withdrawal? For how long?